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PURPOSE: Diagnostic stability for people with First Episode Psychosis (FEP) is essential for treatment, but it remains poorly investigated, especially in adolescents and within a prospective design. The aims of this research were: (a) to examine diagnostic change in Italian adolescents with FEP treated within an "Early Intervention in Psychosis" program during a 2-year follow-up period and (b) to investigate any sociodemographic and clinical predictors at baseline. METHODS: At baseline, 66 adolescents with FEP was recruited. Their primary diagnosis was formulated both at baseline and at the end of follow-up. At presentation, FEP adolescents completed the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). As for diagnostic stability, the Kappa statistic was calculated. The associations of diagnostic change with baseline clinical and sociodemographic features were analyzed using a logistic model with the diagnostic shift as dependent variable. A propensity score was finally calculated based on logistic analysis results. RESULTS: 38 (57.6%) FEP adolescents changed their opening diagnosis. The highest prospective diagnostic stability was for initial diagnosis of schizophrenia (95.4%) and affective spectrum psychoses (75%). Diagnostic instability was high for opening diagnosis of psychosis not otherwise specified, brief psychosis and schizophreniform disorder (100%). The best predictors of diagnostic change were fewer years of education, shorter duration of untreated psychosis and higher baseline levels of psychiatric symptoms. CONCLUSION: Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses is an important challenge for future diagnostic development in early psychosis, especially in adolescence.
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Disorganization is a nuclear dimension of psychosis, especially in schizophrenia. Despite its relevant association with poor prognosis and negative outcomes, it is still under-investigated compared to positive and negative symptoms, in particular at the onset of illness. This study explored disorganization in youth at Clinical High Risk for Psychosis (CHR-P) over a 2-year period. A sample of 180 CHR-P participants (50% males; 51.1% with baseline second-generation antipsychotic medication) recruited within a specialized CHR-P service completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Across the follow-up, we examined key associations of disorganization with other domains of psychopathology, functioning, and treatment response using Spearman's rank correlation coefficients and linear regression analyses. Our results showed a significant longitudinal reduction in disorganization severity levels across the follow-up. This decrease was significantly associated with improvements in negative symptoms and daily functioning, with a shorter duration of untreated psychiatric symptoms, and with baseline equivalent dose of antipsychotic medication. No significant longitudinal associations with other treatment component of the PARMS program were found. Our findings suggest a longitudinal improvement in disorganization dimension in CHR-P individuals, especially in the context of early interventions targeting reduction in the duration of untreated psychiatric symptoms and favoring a prompt antipsychotic therapy.
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BACKGROUND AND HYPOTHESIS: Antipsychotic (AP) prescription in clinical high risk for psychosis (CHR-P) subjects remains a divisive issue. Although official guidelines currently discourage AP treatment in CHR-P, it is common in clinical practice, especially for psychosis prevention. The aim of this study was to investigate whether baseline AP need (especially in high-dose) indexes a CHR-P subgroup with poorer prognosis and differs from AP-naïve subjects in terms of sociodemographic, clinical, and outcome parameters across a 2-year follow-up. STUDY DESIGN: CHR-P participants were treated within an "Early Intervention in Psychosis" program and completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale both at baseline and every 12 months. Individuals with baseline AP prescription were included in the high-dose or low-dose CHR-P-AP+ subgroup. The others were grouped as AP-naïve. Cox regression analyses and mixed-design ANOVA were performed. STUDY RESULTS: 180 CHR-P individuals were enrolled (32 high-dose, 60 low-dose, and 88 AP-naïve). Compared to AP-naive, CHR-P AP+ subgroups showed older age and more severe clinical presentation. High-dose subgroup also had grater functioning decline at entry and poorer functional recovery at follow-up. No inter-group differences in psychosis transition and symptomatic remission were found. Significant improvement in clinical outcomes were found over time in all subgroups. Baseline AP prescription was specifically associated with a more relevant improvement in PANSS total score, and in negative and disorganized symptoms. CONCLUSIONS: Our results suggest that baseline AP need is an important prognostic parameter in CHR-P and should be considered in risk/benefit calculators.
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PURPOSE: Although the stability of current diagnostic criteria for people with First Episode Psychosis (FEP) is essential for treatment, it still remains poorly investigated. As its examination necessarily requires a prospective evaluation of diagnostic trajectories, the aims of the current longitudinal investigation were: (a) to assess diagnostic changes in an Italian FEP population treated within an "Early Intervention in Psychosis" service during a 2-year follow-up period, and (b) to identify potential sociodemographic and clinical moderators of diagnostic instability at entry. METHODS: All participants were FEP individuals, aged 12-35 years. Their primary diagnosis was formulated both at baseline and at the end of the follow-up. At entry, they also completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. As measure of diagnostic stability, the Kappa statistic was first calculated. The associations of diagnostic shift with baseline sociodemographic and clinical characteristics were then analyzed using a logistic model with the diagnostic change as dependent variable. Finally, a propensity score was calculated, based on logistic analysis results. RESULTS: 221 (50.1 %) FEP participants changed their initial diagnosis. The highest prospective diagnostic stability was found for initial diagnosis of schizophrenia (93.9 %) and affective spectrum psychoses (92.4 %). Diagnostic instability was high for initial diagnosis of brief psychotic disorder (100 %), schizophreniform disorder (100 %) and psychotic disorder not otherwise specified (92.1 %). The best predictors of diagnostic change were previous contact with neuropsychiatry services, shorter duration of untreated psychosis and higher baseline levels of disorganization. CONCLUSIONS: Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses and detecting its moderators at entry are important challenges for future diagnostic development of early psychosis.
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Transtornos Psicóticos , Esquizofrenia , Humanos , Transtornos Psicóticos/diagnóstico , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Seguimentos , Criança , Esquizofrenia/diagnóstico , Estudos Longitudinais , Itália , Escalas de Graduação Psiquiátrica/normasRESUMO
Borderline Personality Disorder (BPD) is under-recognized in First-Episode Psychosis (FEP) and its psychotic manifestations are difficult to differentiate from Schizophrenia Spectrum Disorders (SSD). The aim of this investigation was to compare clinical, sociodemographic, and outcome characteristics between FEP patients with BPD vs. FEP subjects with SSD both at baseline and across a 2-year follow-up period. Participants completed the Health of the Nation Outcome Scale (HoNOS), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale both at entry and every 12 months during the follow-up. A mixed-design ANOVA model was conducted to investigate the temporal stability of clinical scores within and between the two subgroups. Among 356 FEP participants, 49 had a BPD diagnosis. Compared to FEP/SSD (n = 307), FEP/BPD patients showed higher prevalence of employment, current substance use, and past attempted suicide. They had a lower equivalent dose of antipsychotic medication at entry and lower levels of negative symptoms. Finally, they had a higher 2-year drop-out rate and a significant improvement in psychopathological scores limited to the first year of treatment. BPD as categorical entity represents a FEP subgroup with specific clinical challenges. Appropriate treatment guidelines for this FEP subgroup are thus needed.
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AIM: The prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period. METHODS: This research was settled within the 'Parma At-Risk Mental States' program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. RESULTS: Hundred and seventy-eight CHR-P individuals (aged 12-25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS 'Positive Symptoms' and 'Negative Symptoms' factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals. CONCLUSIONS: In agreement with increasing empirical evidence, also the results of the current study suggest that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in risk calculators.
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Antipsicóticos , Transtornos Psicóticos , Humanos , Antipsicóticos/efeitos adversos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Estudos Longitudinais , PrognósticoRESUMO
PURPOSE: Since January 2016, the Parma Department of Mental Health (in Italy) developed a specialized care program for Early Intervention (EI) in individuals at Clinical High Risk for Psychosis (CHR-P). As unfavorable outcomes other than transition to psychosis were not systematically reported in the current literature (thereby compromising more sophisticated prognostic stratifications), the aims of this research were (1) to investigate adverse outcome indicators (i.e., service disengagement, psychosis transition, hospitalization, prolonged functioning impairment, prolonged persistence of CHR-P criteria, suicide attempts) in an Italian CHR-P population enrolled within a specialized EI service across a 2-year follow-up period, and (2) to examine their relevant associations with sociodemographic and clinical characteristics of the CHR-P total sample at baseline. METHODS: All participants were young CHR-P help-seekers aged 12-25 years. They completed the "Comprehensive Assessment of At-Risk Mental States" (CAARMS) and the Health of the Nation Outcome Scale (HoNOS). Both univariate and multivariate Cox regression analyses were performed. RESULTS: 164 CHR-P individuals were enrolled in this study. Across the follow-up, 30 (18.0%) dropped out the EI program, 23 (14%) transitioned to psychosis, 24 (14.6%) were hospitalized, 23 (14%) had a prolonged persistence of CHR-P criteria and 54 (47%) showed prolonged impairment in socio-occupational functioning. CONCLUSION: As almost half of our participants did not functionally remit over time, sustained clinical attention for young CHR individuals people should be offered in the longer term, also to monitor unfavorable outcomes and to improve long-term prognosis.
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PURPOSE: Service disengagement is a major concern for "Early Intervention in Psychosis" (EIP). Indeed, identifying predictors of engagement is crucial to maximize mental healthcare interventions in first-episode psychosis (FEP). No Italian study on this topic has been reported to date. Thus, the aims of this investigation were: (1) to examine short-term disengagement rate in an Italian population of FEP patients treated within an EIP service across a 1-year follow-up period, and (b) to assess the most relevant predictors of disengagement in the first year of treatment. METHODS: All participants were young FEP help-seeking patients, aged 12-35 years, enrolled within the "Parma Early Psychosis" (Pr-EP) protocol. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS), the Health of the Nation Outcome Scale (HoNOS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were used. RESULTS: 496 FEP individuals were enrolled in this research. Across the follow-up, a 16.5% prevalence of short-term disengagement was found. Particularly robust predictors of service disengagement were poor baseline treatment non-adherence, living with parents and the presence of brief psychotic disorder or schizophreniform disorder at entry. CONCLUSION: About 16% of FEP patients disengaged the Pr-EP program within the first year of treatment. A solution to reduce disengagement and/or to favor re-engagement of these subjects might be to remain on EIP program caseloads allowing the option for low-intensity support and monitoring, also via remote technology.
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Service disengagement is a major concern for "Early Intervention in Psychosis" (EIP). Indeed, understanding predictors of engagement is important for the effectiveness of mental health interventions, to improve outcome and quality of life, also in adolescents with first episode psychosis (FEP). No specific European investigation on this topic in adolescence has been reported in the literature to date. The aim of this study was to investigate service disengagement rate and predictors in an Italian sample of FEP adolescents treated within an EIP program during a 2-year follow-up period. All participants were adolescents help-seekers (aged 12-18 years) enrolled in the "Parma Early Psychosis" (Pr-EP) program. At baseline, they completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were performed. 71 FEP adolescents were recruited in this research. During the 2 years of our follow-up, a 25.4% prevalence rate of service disengagement was found. Particularly robust predictors of disengagement were lower baseline acceptance of psychosocial interventions, substance abuse at entry, and lower baseline PANSS "Disorganization" factor score. Approximately, 1/4 of our FEP adolescents disengaged from the Pr-EP program during the first 2 years of treatment. A possible solution to decrease disengagement and to favor re-engagement of these young individuals might be to provide the option of low-intensity monitoring and support, also via remote technology.
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Negative Symptoms (NS) severely affect real-world functioning also in young people at UHR for developing psychosis. However, longitudinal research on beneficial effects of specialized treatments for NS in UHR people is still relatively scarce and inconclusive, especially in real-world care settings. The aims of the present research were: (1) to evaluate the longitudinal stability of NS levels in young UHR subjects treated within a specialized "Early Intervention in Psychosis" (EIP) program across a 2-year follow-up period, and (2) to investigate any relevant association of NS changes with the specific treatment components offered within the EIP program. One hundred UHR individuals (aged 12-25 years) completed the Positive And Negative Syndrome Scale (PANSS). A multiple linear regression analysis was conducted to examine significant associations between longitudinal changes in NS severity levels and the EIP treatment components. Across the follow-up, a significant decrease in NS clinical severity was observed. This reduction was associated with the intensity of individual psychotherapy sessions provided in the first year of treatment, a shorter duration of untreated illness at entry and the 2-year longitudinal decrease in positive symptom levels. In conclusion, NS are relevant in UHR people, but decrease over time together with the delivery of specialized EIP interventions. Specifically, our results showed that individual psychotherapy may reduce the clinical severity of NS at least during the first year of treatment.
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Transtornos Psicóticos , Humanos , Adolescente , Seguimentos , Transtornos Psicóticos/terapia , Transtornos Psicóticos/diagnóstico , Fatores de Tempo , PsicoterapiaRESUMO
Hedonic deficits have been extensively studied in schizophrenia, but little is known about their association with suicidal ideation in early psychosis. The aim of this research was to examine the relationship between anhedonia and suicidal thoughts across a 2-year follow-up period in people with First Episode Psychosis (FEP) and at Ultra High Risk (UHR) of psychosis. Ninty-six UHR and 146 FEP, aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II). The BDI-II "Anhedonia" subscale score to assess anhedonia and the CAARMS "Depression" item 7.2 subscore to measure depression were used across the 2 years of follow-up. Hierarchical regression analyses were performed. No difference in anhedonia scores between FEP and UHR individuals was found. In the FEP group, a significant enduring association between anhedonia and suicidal ideation was found at baseline and across the follow-up, independent of clinical depression. In the UHR subgroup, the enduring relationship between anhedonia and suicidal thoughts were not completely independent from depression severity. Anhedonia is relevant in predicting suicidal ideation in early psychosis. Specific pharmacological and/or psychosocial interventions on anhedonia within specialized EIP program could reduce suicide risk overtime.
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Transtorno Depressivo Maior , Transtornos Psicóticos , Humanos , Adolescente , Ideação Suicida , Seguimentos , Transtornos Psicóticos/psicologia , AnedoniaRESUMO
Objective: Comorbid depression is quite common in early psychosis and specifically related to suicidal behavior and poor long-term outcomes. However, Depressive Symptoms (DS) are often neglected in both research and treatment, especially at the psychosis onset. The goals of this investigation were: (a) to longitudinally explore DS levels in patients with First Episode Psychosis (FEP) during 24 months of follow-up, and (b) to investigate the associations of DS with psychopathology and intervention components of an "Early Intervention in Psychosis" (EIP) program across the follow-up period. Method: The Global Assessment of Functioning (GAF) and the Positive And Negative Syndrome Scale (PANSS) were completed by 266 FEP subjects. A linear regression analysis with DS as the dependent parameter and psychopathological and treatment characteristics as independent variables was performed (both at baseline and across the follow-up period). Results: DS had enduring associations with PANSS "Positive Symptoms" and "Negative Symptoms" subscores. During the investigation, FEP subjects significantly improved their DS severity levels. This was related to the number of individual psychotherapy meetings supplied within the EIP protocol, as well as to a higher antidepressant dose and a lower antipsychotic dose prescribed during the follow-up. Conclusions: DS are quite prominent in FEP, even at the recruitment time in EIP services. Nevertheless, DS severity tends to diminish overtime, especially with the provision of specialized EIP treatments.
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Introduction: Depression in schizophrenia is associated with poor outcomes and suicide risk. However, it is overlooked in both research and clinical practice, especially in First Episode Schizophrenia (FES). Methods: In this letter to the editor, we reported relevant findings on relevant comorbid depressed mood in an Italian sample of FES patients during a 1-year follow-up period within an "Early Intervention in Psychosis" (EIP) program. The Positive And Negative Syndrome Scale (PANSS) was completed by 159 participant. Results: At baseline, 53 (33.3%) participants showed a relevant depressed mood (as measured with a PANSS "Depression" G6 item subscore of ≥ 5). At entry, a relevant depressed mood was associated with a greater percentage of females and a higher PANSS "Positive Symptoms" score. Across the follow-up, FES individuals improved their depression severity levels. This reduction was significantly related to improvments in positive symptoms levels. Conclusions: Depression is relatively common in FES, already at the recruitment in EIP services. However, its severity decreases overtime within specialized EIP programs.
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Transtornos Psicóticos , Esquizofrenia , Feminino , Humanos , Esquizofrenia/complicações , Seguimentos , ItáliaRESUMO
INTRODUCTION: Disorganization is a crucial domain in affective psychoses. However, it has received poor research attention, especially at the illness onset. The aims of this study were: (a) to monitor the longitudinal course of disorganization in young people with first episode affective psychosis (FEAP) across 2 years of follow-up, and (b) to investigate any relevant correlation of disorganized symptoms with psychopathology, functioning and the specific treatment elements of an "Early Intervention in Psychosis" (EIP) protocol along the follow-up period. MATERIALS AND METHODS: Seventy-five FEAP participants (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman's rank correlation coefficients were calculated. RESULTS: During the follow-up, disorganized symptoms showed significant enduring positive correlations with PANSS items representing delusional thought content and uncooperativeness, as well as a persistent negative association with the GAF score. Across the 2-year follow-up period, FEAP individuals also had a relevant reduction in disorganization levels. This symptom decrease was specifically related with the combination of antipsychotic medication with the specific psychosocial components of our EIP intervention offered to FEAP patients during the first 12 months of treatment. CONCLUSIONS: Disorganization is relevant in FEAP subjects already at their enrollment in specialized EIP protocols. However, it decreases over time, together with the delivery of specific, combined (person-tailored) EIP interventions.
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Antipsicóticos , Transtornos Psicóticos , Humanos , Adolescente , Transtornos Psicóticos Afetivos/tratamento farmacológico , Transtornos Psicóticos/diagnóstico , Seguimentos , Antipsicóticos/uso terapêutico , PsicopatologiaRESUMO
Depression is common in schizophrenia and is correlated with suicide risk and poor long-term outcomes. However, the presence of depressive symptoms is often underestimated in both research and treatment, particularly at the illness onset. The goals of this study were: (a) to longitudinally observe anxious-depressive symptom levels in patients with First Episode Schizophrenia (FES) during a 24 months of follow-up period, and (b) to examine their associations with other psychopathology and the intervention patients received in an "Early Intervention in Psychosis" (EIP) program during the follow-up period. The Global Assessment of Functioning (GAF) and the Positive And Negative Syndrome Scale (PANSS) were completed by 159 FES patients both at baseline and across the follow-up. Data were analyzed by linear regression analysis and Spearman's coefficients. Anxious-depressive symptoms had significant longitudinal associations with GAF deterioration and PANSS "Positive Symptoms", "Negative Symptoms" and "Disorganization" subscores. During the follow-up period, FES participants significantly improved the level of anxious-depressive symptoms. This was significantly associated with the number of case management and individual psychotherapy meetings the patient engaged in, as well as with lower antipsychotic doses prescribed during the follow-up period. In conclusion, anxious-depressive symptoms are prominent in FES and at the initial entry into EIP programs. Anxious-depressive symptom severity tends to diminish overtime, especially with the provision of specialized EIP treatments. However, since we did not have a control population studied in parallel, we cannot say whether these results are specific to the protocols of EIP programs or just to the intensity of engagement in care.
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Antipsicóticos , Transtornos Psicóticos , Esquizofrenia , Humanos , Esquizofrenia/complicações , Esquizofrenia/terapia , Esquizofrenia/diagnóstico , Depressão/epidemiologia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/terapia , Transtornos Psicóticos/diagnóstico , Psicopatologia , Escalas de Graduação PsiquiátricaRESUMO
Aberrant salience (AS) is considered as a predisposing factor in early psychosis. Although it has been frequently examined in the general population as a measure of vulnerability to psychotic disorder, empirical evidence on AS in prodromal phases of psychosis is still relatively scarce. Thus, the aims of this research were (1) to investigate any significant association of AS with functioning, psychopathology and treatment components of an "early intervention in psychosis" program in a sample of young community help-seekers at Ultra-High Risk (UHR) of psychosis along a 1-year follow-up period, and (2) to longitudinally monitor the stability of AS across the 1 year of follow-up. Participants (87 UHR), aged 13-35 years, completed the Aberrant Salience Inventory (ASI), the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the brief version of the Schizotypal Personality Questionnaire (SPQ-B) at baseline and after the 1 year of follow-up. Spearman correlation analyses among psychopathological parameters and specialized treatment components were performed. A multiple linear regression analysis was also carried out. After a 1-year follow-up period, UHR subjects had a statistically relevant decrease in ASI total scores. This was significantly related to the number of individual cognitive-behavioral therapy (CBT) sessions and the number of family psychoeducational sessions offered to UHR participants and their family members during the same 12-month period. In conclusion, AS is clinically relevant in UHR individuals. However, it seems to improve over time along with the delivery of tailored, specialized psychosocial interventions for early psychosis.
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Transtornos Psicóticos , Adolescente , Adulto , Humanos , Estudos Longitudinais , Sintomas Prodrômicos , Escalas de Graduação Psiquiátrica , Psicopatologia , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Inquéritos e Questionários , Adulto JovemRESUMO
AIM: Negative symptoms (NS) severely affect daily functioning already at the psychosis onset. However, most studies investigating beneficial effects of specific treatments for NS mainly included individuals with prolonged psychotic disorders. Furthermore, evidence on psychosocial rehabilitation for NS in early psychosis is still relatively poor. The aims of this study therefore were (A) to longitudinally examine NS stability in people with first episode psychosis (FEP) along a 2-year follow-up period, and (B) to overtime explore any relevant association of NS levels with the specific intervention components of an 'early intervention in psychosis' (EIP) protocol during the follow-up. METHODS: At baseline, 266 FEP subjects (aged 12-35 years) completed the positive and negative syndrome scale (PANSS). Multiple linear regression analyses were then performed. RESULTS: Along the follow-up, FEP participants had a relevant improvement in NS levels. This was specifically predicted by the total number of case management sessions offered within our 2-year EIP protocol, as well as by shorter duration of untreated psychosis at entry and by longitudinal reduction in PANSS depressive and positive symptom dimension levels. No association with antipsychotic medication was found. CONCLUSIONS: NS are clinically relevant in FEP, already at the recruitment time in specialized EIP services. However, their severity appears to improve over time together with the delivery of patient-tailored, integrated EIP case management.
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Antipsicóticos , Transtornos Psicóticos , Humanos , Seguimentos , Administração de Caso , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Antipsicóticos/uso terapêutico , Fatores de TempoRESUMO
Negative symptoms (NS) severely interfere with real-world performance, already at the onset of schizophrenia and in "clinical high risk" mental states. However, most of the empirical studies specifically examining treatment effectiveness on NS included patients with stable, prolonged schizophrenia. Moreover, research on psychosocial interventions for NS in early schizophrenia is still relatively scarce. Thus, the aims of this study were (1) to longitudinally monitor the NS stability in young individuals with First Episode Schizophrenia (FES) across a 2-year follow-up period, and (2) to investigate any significant association of NS with functioning, other aspects of FES psychopathology and the specific treatment component effects on NS of an "Early Intervention in Psychosis" (EIP) program during the 2 years of follow-up. At entry, 159 FES participants (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman's correlations and multiple linear regression analyses were performed. NS had relevant enduring associations with PANSS disorganization scores and GAF functioning decline. Across the follow-up, FES individuals showed a significant improvement in NS levels. This was specifically associated with the number of individual psychotherapy and intensive case management sessions provided during the 2 years of our EIP program, as well as with the antipsychotic dosage at entry. NS are clinically relevant in FES, already at the enrollment in specialized EIP services. However, their clinical severity seems to decrease over time, together with the delivery of specific, patient-tailored EIP interventions.
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Antipsicóticos , Transtornos Psicóticos , Esquizofrenia , Antipsicóticos/uso terapêutico , Seguimentos , Humanos , Psicopatologia , Transtornos Psicóticos/diagnóstico , Esquizofrenia/tratamento farmacológicoRESUMO
OBJECTIVE: The early identification of adolescents at the onset of psychosis is crucial to provide effective interventions. The aim of this study is to examine the validity of the "early detection Primary Care Checklist" (PCC) in an Italian adolescent population. The PCC is a 20-item tool designed to assist primary care practitioners in identifying young people with early psychosis. METHODS: The checklist was completed by the referring practitioners of 129 adolescents. The validity of this instrument was established by comparing screen results with the "Comprehensive Assessment of At-Risk Mental States." RESULTS: The simple checklist had excellent 98% sensitivity, but low specificity (58%). Using only a PCC total score of ≥20 as cutoff, there was a substantial improvement in specificity (87%). CONCLUSION: The Italian version of the PCC performed well to identify adolescents in the early stage of psychosis and may be used in primary care settings.